philhealth updates
TRANSCRIPT
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PHILHEALTH UPDATES2nd Semi-Annual Hospital Managers Meeting
OUTLINE OF PRESENTATION
PhilHealth Directions in Relation to KP Including Status of PhilHealth Membership, Collection and EngagementImplementing Rules and Regulations of RA 10606New PhilHealth ProgramsBenefits Payment and AvailmentOpen Forum
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Atty. Jerry F. IbayRegional Vice PresidentPhilHealth-CAR
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Synergy for Universal Health Care
KP Vision Financial Risk Protection
Access to Improved Health Facilities
Attainment of Health-related MDG Bawat Pilipino Miyembro
Bawat Miyembro Protektado
Kalusugan Natin Segurado
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Outcomes and Strategies of UHC
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Outcome 2: Financial Risk Protection* Depends on NHTS list of DSWD
Strategy 1: Expand PhilHealth CoverageActionStatusTARGETS201420152016Enroll NHTS poor & near-poor families5.2 M14.7 M*14.7 M14.7 M
Increase hospitals with point of care enrollmentLGU
DOH100
72200
72300
72
Enroll the remaining informal sector80%3.1M not enrolled but can pay premium858890
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84%76%86%
Chart1
17007375428079023451445152
24285369379108594177793
117746304475588186328
341775161473189421350894
429173132540229027361567
20093048076104978153054
21069858234120315178549
1584824265894129136787
85%
73%
73%
103%
85%
Population
No. of Members
No. of Dependents
Total
Number of PhilHealth Members and Dependents As of September 2013 By Province, CAR
Sheet1
PopulationNo. of MembersNo. of DependentsTotal
CAR1,700,737542,807902,3451,445,152
Abra242,85369,379108,594177,793
Apayao117,74630,44755,88186,328
Baguio City341,775161,473189,421350,894
Benguet429,173132,540229,027361,567
Ifugao200,93048,076104,978153,054
Kalinga210,69858,234120,315178,549
Mt. Province158,48242,65894,129136,787
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Number and Percentage Distribution of Members and Dependents as of September 2013, CAR
Chart1
1891830.13
2278240.16
5546680.38
3118060.22
1301030.09
315680.02
Total = 1,445,152
Number
Percentage
Sheet1
CategoryNumberPercentage
Government189,18313%
Private227,82416%
Sponsored554,66838%
Individually Paying311,80622%
OFW130,1039%
Lifetime31,5682%
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Summary of Licensed vs Accredited/Engaged Hospitals per province per year:
201120122013LICENSEDENGAGEDLICENSEDENGAGEDLICENSED ENGAGEDABRA10999109APAYAO777777BAGUIO CITY868686BENGUET999999IFUGAO888888KALINGA987788MT. PROVINCE777777TOTAL585455535754
Chart1
9769887
9769877
9769887
Abra
Apayao
Baguio City
Benguet
Ifugao
Kalinga
Mt. Province
Summary of the Number Hospitals Engaged/Accredited in CAR from 2011 - 2013
Sheet1
AbraApayaoBaguio CityBenguetIfugaoKalingaMt. Province
20119769887
20129769877
20139769887
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Hospitals With Out-Patient Benefit Package Services
OPB ServicesProvince/CityHospitalTBDOTSBenguetBaguio CityBenguet Gen. Hospital (BeGH) Baguio Gen. Hospital & Medical Center (BGHMC)St. Louis Hospital of the Sacred Heart (SLUHSH)Notre Dame de Chartres HospitalHemodialysisBenguetBaguio CityBeGHBGHMCSLUHSHNotre Dame de Chartres Hospital Pines City Doctors HospitalAnimal BiteAbraKalinga
Mt. ProvinceAbra Provincial HospitalKalinga Provincial HospitalWestern Kalinga District HospitalBontoc General HospitalLuis Hora Memorial Regional Hospital
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Hospitals With Out-Patient Benefit Package Services
OPB ServicesProvince/CityHospitalPCBAbra
Apayao
Baguio CityAbra Provincial Hospital
Bucay MunicipalHospitalDolores Medicare and Community HospitalLa Paz District HospitalVillaviciosa Medicare and Community Hospital
Amma Jadsac District HospitalFlora District HospitalSta. Marcela Med. and Community HospitalFar North Luzon Gen. Hosp. & Trng. Center
Baguio Gen. Hospital and Medical Center
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Hospitals With Out-Patient Benefit Package Services * Above Packages to expire on December 31, 2013.
Province/CityHospitalPCBKalinga
Mt. Province
Kalinga Provincial HospitalJuan M. Duyan District HospitalKalinga District HospitalPinukpuk District HospitalWestern Kalinga District Hospital
Bontoc General HospitalBarlig District HospitalBesao District HospitalParacelis District HospitalLuis Hora Memorial Regional HospitalNatonin Community Hospitals
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Premium Collection vs Benefit Availment, Jan. September 2013CollectionBenefit Payment P412,899,000 or 68% of the annual collection target
P875,362,714.18 or 71%% of the annual budget for benefit payment2013 Annual Premium Target CollectionP603,084,000.002013 Annual Budget for Benefit PaymentP603,084,000.00
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PFPR Paid to Different Hospitals as November 19, 2013
Province/HospitalAmount ReleasedAbra1. Bucay Municipal HospitalP16,400.002. Dolores Medicare and Community HospitalP41,600.003. La Paz District HospitalP65,459.86Apayao1. Far North Luzon Gen. Hospital & Training CenterP123,000.00Kalinga1. Kalinga Provincial HospitalP258,500.002. Juan M. Duyan District HospitalP181,500.03. Kalinga District HospitalP172,000.004. Pinukpuk District HospitalP222,500.005. Western Kalinga District HospitalP176,250.00
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PFPR Paid to Different Hospitals as November 19, 2013
Province/HospitalAmount ReleasedMt. Province1. Bontoc General HospitalP958,760.002. Barlig District HospitalP115,784.513. Besao District HospitalP351,636.674. Paracelis District HospitalP14,250.005. Luis Hora Memorial Regional HospitalP9,250.00Grand TotalP2,706,891.31
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*Funding Requirements to Cover the Poor and Near Poor
No. of FamiliesPremium @ P2,400DSWD Poor(Submitted for 2014 GAA)Principal Families5.48 millionPhP 13.15 billionOther families in the list4.74 millionPhP 11.38 billionTOTAL10.22 millionPhP 24.53 billion
No. of FamiliesPremium @ P2,400DSWD Near PoorPrincipal Families2.41 millionPhP 5.78 billionOther families in the list*2.08 millionPhP4.99 billionTOTAL4.49 millionPhP 10.77 billion
PAMANA and BANGSAMORO 17, 500 Php 42.00 millionGrand Total14.72 millionPhP 35.34 billion(35,337,657,600)
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*Funding Requirements to Cover the Poor and Near Poor
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EXPANDED COVERAGE as Stated in RA 10606Enroll the remaining vulnerable groupsWomen about to give birth (and as determined by means test recognized by DSWD) (Sec 21, RA 10606)
Barangay health workers, nutrition scholars, and other volunteer workers of the LGU. (Sec 20, RA 10606)
Workers rendering services in government offices such as job order, project-based contractors, and the like (paragraph 3, Sec. 5, Rule I, Title III of the IRR of RA 10606)
Require PhilHealth membershipMake PhilHealth membership a mandatory requirement for doing business or issuing professional or business license or permit like (paragraph 3, Sec. 6 of RA 10606)
Point of CareCover the unenrolled poor and protect them from the financial risks of ill-health at point of care.
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Outcome 2: Financial Risk Protection* Depends on NHTS list of DSWD
Strategy 2: Improve Benefit PackageActionStatusTARGETS2014201520161. Implement No-Balance BillingLGUs: 6%
DOH: 11% 15
5035
8050
90 2. Increase access to primary Care Benefit Package5.4 M NHTS Families14.7 M*14.7 M14.7 M3. Implement Case Rates to all conditions12 Surgical 11 Medical ConditionsAll surgical and medical conditions4. Expand Catastrophic Care Package (Type Z)8 conditions122025
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Preventive and curative care
Ensure No-Balance Billing (NBB) implementation - No other out-of-pocket expenses will be charged from sponsored members confined in government facilities beyond the prescribed benefit package rates of PhilHealth.
Primary Care Benefit I diagnostic examination including complete blood count, urinalysis, fecalysis, sputum microscopy, fasting blood sugar, lipid profile, chest x-ray and primary preventive services
Primary Care Benefit II outpatient medication for hypertension, diabetes and dyslipidemia
Special Benefit Packages TB treatment through DOTS, Maternity Care Package, Malaria Treatment, HIV/ AIDS treatment, Animal Bites
Z-Benefit Packages health packages for catastrophic conditions
Implementation of All Case rate payments as a more efficient provider payment mechanism.IMPROVED BENEFIT PACKAGE
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Continuing PhilHealth Efforts and Activities in the HospitalsDeployment of PhilHealth Customer Assistance Relations Empowerment Staff (PCARES)Best Efforts to reduce turn-around time in processing claims. (CAR is the 3rd place nationwide - fastest TAT in claims processing, 2012)Priority Lane for NBB Claims through the Reg Tag CornerStudy/Survey Regarding Membership Status of Patients Admitted in HospitalsThe Benguet General Hospital Project Iwas RTH
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Planned Activities For 2013 and BeyondPoint of Care Engagement of HospitalsIncrease Hospitals Implementing NBB Orientation of the ACR by Province starting 4th week of November 2013Expansion of Study/Survey on Membership Status of Admitted Patients in Private Hospitals
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*** Estimated Figure** Estimated Figure***